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Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study.

https://arctichealth.org/en/permalink/ahliterature136981
Source
Circ Arrhythm Electrophysiol. 2011 Apr;4(2):149-56
Publication Type
Article
Interactive/Multimedia
Date
Apr-2011
Author
Luiz R Leite
Simone N Santos
Henrique Maia
Benhur D Henz
Fábio Giuseppin
Anderson Oliverira
André R Zanatta
Ayrton K Peres
Clarissa Novakoski
Jose R Barreto
Fabrício Vassalo
Andre d'Avila
Sheldon M Singh
Author Affiliation
Instituto Brasília de Arritmia, Brasilia, Brasil.
Source
Circ Arrhythm Electrophysiol. 2011 Apr;4(2):149-56
Date
Apr-2011
Language
English
Publication Type
Article
Interactive/Multimedia
Keywords
Adult
Aged
Atrial Fibrillation - surgery - ultrasonography
Body temperature
Burns - diagnosis - etiology - prevention & control
Catheter Ablation - adverse effects - instrumentation
Catheters
Chi-Square Distribution
Equipment Design
Esophageal Fistula - diagnosis - etiology - prevention & control
Esophagoscopy
Esophagus - injuries - physiopathology - ultrasonography
Female
Humans
Male
Middle Aged
Monitoring, Intraoperative - instrumentation - methods
Ontario
Pilot Projects
Predictive value of tests
Prospective Studies
Ulcer - diagnosis - etiology - prevention & control
Ultrasonography, Interventional - instrumentation
Abstract
Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation.
Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy.
A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.
PubMed ID
21325208 View in PubMed
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Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature257997
Source
Heart Rhythm. 2014 Mar;11(3):386-93
Publication Type
Article
Date
Mar-2014
Author
Raphaël P Martins
David Hamon
Olivier Césari
Albin Behaghel
Nathalie Behar
Jean-Marc Sellal
Jean-Claude Daubert
Philippe Mabo
Dominique Pavin
Author Affiliation
Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France. Electronic address: raphael.martins@chu-rennes.fr.
Source
Heart Rhythm. 2014 Mar;11(3):386-93
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Atrial Fibrillation - surgery - ultrasonography
Balloon Occlusion - methods
Cryosurgery - methods
Echocardiography
Female
Humans
Male
Middle Aged
Patient Safety
Phrenic Nerve - injuries
Treatment Outcome
Abstract
Compared with the first-generation Arctic Front cryoballoon (ARC-CB), the new Arctic Front Advance cryoballoon (ARC-Adv-CB) increases the efficient CB-tissue contact surface during freezing, which may increase the incidence of phrenic nerve (PN) palsy (PNP).
To evaluate the safety and efficacy of paroxysmal atrial fibrillation (AF) ablation with the ARC-Adv-CB as well as the merits of a predictor of PNP.
AF ablation was performed by using a "single 28-mm big CB" approach. The rate of pulmonary vein (PV) isolation with a first cryoapplication was measured. The distance between the CB and a PN pacing catheter in the superior vena cava was measured to predict PNP during freezing.
In 147 patients, PV were isolated with a single cryoapplication in 205 (81.3%) of 252 PV treated with the ARC-CB and in 280 (90.3%) of 310 PV treated with the ARC-Adv-CB (P = .003). The mean time to PV isolation was 52 ± 34 seconds and 40 ± 25 seconds (P
PubMed ID
24389575 View in PubMed
Less detail